Who gets a say in public health nutrition? Five perspectives from the field

A painting of 7 people, one holding a baby,

Christina Zorbas, Andrew Brown, Phoebe Nagorcka-Smith, Veronica Nunez, Dheepa Jeyapalan

Introduction:

A core tenet of public health nutrition is identifying and enacting actions to equitably improve population nutrition. We should act in a manner that proportionately addresses structural drivers of social and/or economic disadvantage. The increased focus on better including people’s ‘lived experience’ is one example of an attempt to challenge inequities in public health nutrition decision-making. But what does it mean and why does it matter? We offer five diverse experiences to answer these questions.

 

Let’s talk about voice and power

By Christina Zorbas

My interests in nutrition and health equity stemmed from my upbringing in a Greek Australian migrant family and my experiences with chronic health issues. At 10 I was diagnosed with Juvenile Arthritis, and Systemic Lupus Erythematosus at 20. These early life experiences made me understand what it’s like to have the odds stacked against you, and curious about how we can break down seemingly impossible barriers to optimal wellbeing – for all.

As a public health nutrition researcher, I’ve been lucky enough to be heard and be given opportunities by formidable leaders. They’ve shared their power with me, and given me the space to both heal and lead, as required. But I’ve also experienced the institutionalised power-over approach that (knowingly or not) perpetuates unjust structures and keeps certain types of people in charge, and others silent.

If we are to disrupt inequities in population nutrition, we need to recognise that power is not finite. We can all consciously and actively share our power by creating safe spaces for people who have experienced disadvantage to speak, be heard, lead, and co-create.

 

 

Challenging the notion of the ‘expert’

By Andrew Brown

I’m often surprised when a public health nutrition colleague expresses fear that community members may come up with ‘ideas that are not evidence-based.’ I understand it comes from a good place: we do have some expert evidence about how to promote nutrition, and we want that evidence applied to maximise positives for everyone.

Yet, our evidence-base overly represents white, straight, cisgender, temporarily able-bodied men – which indicates that we ought to remain humble and fully aware of where the gaps lie in our assumptions about its applicability to community members. As a gay man, I’m intimately familiar with how assumptions can be untrue.

Social work offers us a great set of tools and frameworks that can guide us to forgo such assumptions and let people define themselves. This includes tools like strengths-based approaches and asset-based community development.

To improve our evidence base, we need to recognise that community members are experts in their own lived experiences of food systems and make genuine efforts to improve systems in ways that are most meaningful for people. Consider how to involve community members early when designing nutrition actions, and how you can give them nutrition decision-making power.

Often, challenging our own internal biases about community members, and taking a step outside of our comfort zone to listen and learn with an open mind, are steps towards equitable nutrition actions.

 

Gender stigma in public health nutrition

By Phoebe Nagorcka-Smith

I recently read a textbook (which shall remain nameless) about community collaboration and was displeased, but unsurprised, that women were invisible in stories of work and success, but central in the narrative of social and moral decline.

I’ve seen this in community-based prevention too. ‘Women undertaking more paid work’ (but only when it’s paid) inevitably creeps into discussions about why children aren’t eating enough fruit and vegetables. Solutions (such as ‘homemade’ canteen food) often rely on unpaid work from community members who are disproportionately likely to be women (see here and here). It sets up a dynamic where women are shamed for child nutrition issues, and asked to redress it by more free labour.

This, in a country where women already do more housework, child and elder care, volunteering, and where they are more likely to work in precarious employment that makes extra commitments difficult. Structural determinants of food access and intake such as low social security rates, unstable and low-paid employment, and poor transport connections – all more likely to hurt women – are rarely mentioned.

Adding a critical gender lens to public health nutrition discussions is critical to reducing both stigma and the likelihood of perpetuating gender inequities. Ask: who is being hurt, and who is being protected, in how we talk about these issues? Who will do the work, and what will it cost them?

 

Reflecting on demographics and intersectionality

By Dheepa Jeyapalan and Veronica Nunez

Food is so much more than nutrition. It is connection, comfort, and memories. In Australia, food is often how people from culturally diverse backgrounds feel like we can truly express ourselves and feel at ‘home’.

The demographics of the food systems sector, encompassing public health, dietetics, and environmental sustainability, seldom represents the communities that we often work with. At conferences and professional events, the lack of cultural diversity and First Nations’ voices is apparent.

The voices we choose to amplify hold weight. Today’s message is that working with Australians who hold the most privilege is the norm. Working with culturally diverse people and Aboriginal and Torres Strait Islander peoples (the ‘others’/ the ‘hard to reach’) is an extra consideration.

When you plan your next conference or event, it is important to ensure First Nations’ voices are at the table first and foremost. Next, ensure intersectional representation from communities who experience structural discrimination. It is better to work our way out than tack on diversity later.

If these priority voices aren’t participating in our events, we should stop and reflect. Why do some community groups not want to be there? Is our sector reimbursing cultural knowledge appropriately? Are there historical injustices that we might be representing? Do we need to first repair relationships with the communities we want to engage?

 

As we progress our mission to achieve equitable population nutrition, we need to rethink whose voices and agendas dominate our sector. And whose voices are we not hearing? How is this affecting our ability to meaningfully work with communities who have been sidelined?

We can all be proactive by listening, sharing power, reflecting on evidence, language and biases, and building meaningful relationships with communities facing the most structural disadvantage.

 

Christina Zorbas, Andrew Brown, and Phoebe Nagorcka-Smith are early career researchers within the Institute for Health Transformation at Deakin University. Veronica Nunez and Dheepa Jeyapalan are public health nutritionists at the Victorian Health Promotion Foundation (VicHealth).

 

Image: Miles Peacock/Unsplash

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